To explore Magnetic Resonance(MR) perfusion imaging as a biomarker to predict outcome of patients with acute and subacute stroke. Contrast bolus perfusion imaging and arterial spin labeling were conducted in included patients. Imaging evaluation of hemodynamic status, collateral and antegrade flow were assessed. Patients were followed up to record radiological and clinical outcome.
Patients with cerebral ischemia sympton of anterior circulation onset in 48 hours were included. Baseline materials, NIH stroke scale score, modified Rankin Scale at admission, stroke causes, time from sympton onset to imaging were recorded.
Imaging scan were conducted at admission, 7 days after admission and 30 days after admission.
MRI scan protocols: T2 weighted image, T1 weighted image, Diffusion weighted image(DWI), fluid-attenuated inversion recovery(FLAIR), Perfusion weighted image(PWI), arterial spin labeling(ASL) with Post labeling delay(PLD) 1.5s and 2.5s, Territory ASL(TASL) (PLD = 2.0s), 3D inversion recovery (IR)-prepared fast spoiled gradient recalled echo (FSPGR).
Omniscan 2ml/kg, Inject rate：3ml/s
Digital subtraction angiography(DSA) protocols:
Selective angiography and imaging phase from arterial phase to late venous phase.
Antegrade flow assessment from ASL Cerebral blood flow(CBF) map. Collateral flow assessment from ASL CBF map, ASL subtraction CBF map, TASL, PWI postprocessing map, FLAIR hyperintensity vascular sign.
Reperfusion assessment from ASL CBF map, TASL Initial infarct volume measurement form DWI. Final infarct volume measurement from FLAIR. DWI-ASPECTS from DWI. Stroke lesions pattern assessment from DWI. DSA antegrade and collateral grade using modified Thrombolysis in Cerebral Infarction(TICI) scale and The American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral grading system.
Intravenous recombinant tissue plasminogen activator(rtPA), endovascular therapy and conventional treatment including neuro protection, ante-platelet and statin.
Seven days and a month after imaging follow up and clinical stroke event and modified Rankin Scale(mRS) record in 1 year.
- MRI Procedure
Intervention Desc: MRI perfusion imaging, including contrast bolus perfusion imaging and arterial spin labeling. ARM 1: Kind: Experimental Label: Stroke Description: Ischemic stroke patients with sympton onset in 48 hours and no contradiction to MRI scan
- Observation: Case-Only
- Perspective: Prospective
- Sampling: Probability Sample
Ischemic stroke patients with sympton onset in 48 hours
|Type||Measure||Time Frame||Safety Issue|
|Primary||Stroke event||Three months to 1 year||Yes|
|Secondary||Final infarct volume||Seven days to 1 month||Yes|
|Secondary||modified Rankin Score||Three months to 1 year||Yes|